A new study, the first of its kind to compare levels of career satisfaction across multiple medical disciplines, says most physicans are satisfied with their careers, but that high levels of dissatisfaction among practitioners in the fields of obstetrics/gynecology, ophthalmology, orthopaedic surgery, internal medicine, and otolaryngology have important implications for professional societies, which need to address the reasons for such high levels of dissatisfaction.

Physicians who specialize in the treatment of children, newborns, the elderly and skin disorders and who practice in the New England and West Central regions of the country are more satisfied with their careers than their colleagues in other specialties and regions, say researchers at the UC Davis School of Medicine and Medical Center.

The finding, based on a study of more than 12,000 physicians representing 33 medical disciplines, found an overwhelming majority of physicians, more than 70 percent, were 'satisfied' or 'very satisfied' with their careers, and nearly 20 percent were dissatisfied. Satisfaction levels varied according to specialty, geographic region, practice type and country of medical education. Published in the July 22 issue of the Archives of Internal Medicine, the study is the first of its kind to compare levels of career satisfaction across multiple medical disciplines.

"The high satisfaction levels that we found in our study are testaments to the enduring rewards of the science and practice of medicine despite the challenges of a changing health-care system," said J. Paul Leigh, professor of epidemiology and preventive medicine at UC Davis School of Medicine and Medical Center and lead author of the study. "But it also raises a red flag on those specialties that may be underpopulated in the future if we ignore the causes of physician discontent."

Specialties reporting a relatively high level of career satisfaction include pediatrics, perinatal medicine, neonatal care, geriatric internal medicine and dermatology. High levels of dissatisfaction were more commonly reported in obstetrics/gynecology, ophthalmology, orthopaedic surgery, internal medicine and otolaryngology.

"The results demonstrate that all specialties are not created equal in terms of career satisfaction," said Leigh. "These findings have important implications for physicians, their professional organizations, residency directors, managed-care administrators and students selecting a specialty. To maintain the standard of high- quality, affordable health care for all Americans, it is necessary to achieve a balance in the specialty mix. We need to understand why physicians in these specialties report such high levels of distress. We cannot afford to have the supply of ob-gyn physicians, for example, drop to dangerously low levels."

Across specialties, higher income was associated with greater career satisfaction. Other factors linked to high levels of career satisfaction include living in the Northeastern and West North Central regions of the United States, practicing in a rural area or small town, and having little involvement with managed care . Despite the differences among specialties, the study found no significant difference based on gender. Other key findings include differences based on:

* Region. The study found higher career satisfaction among specialists in New England (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut); and West North Central States (Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska and Kansas). By comparison, the results show high levels of career dissatisfaction in the South Atlantic ((Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida), Mountain (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada), Pacific (Washington, Oregon, California, Alaska, Hawaii) and West South Central states (Arkansas, Louisiana, Oklahoma, Texas).

* Age. Dissatisfaction tends to rise with age.

* Practice Type. Specialists in sole proprietorships showed higher levels of career dissatisfaction. In addition, more work hours are associated with higher levels of dissatisfaction.

* Medical Education. Graduates of foreign medical schools indicated significantly higher levels of career dissatisfaction.

"To ensure quality care, it is vitally important to maintain a certain level of physician morale," said Richard L. Kravitz, professor of internal medicine and director of the UC Davis Center for Health Services Research in Primary Care. "Other studies have shown that when physician morale plummets, doctor-patient communication suffers."

The study was funded by a grant from the Robert Wood Johnson Foundation.